MEDICARE: DR. PETER MICHAEL BULOW M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	2275531	NY

General Provider Information

NPI Number	:	1457503211
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER MICHAEL BULOW M.D.

Provider Business Mailing Address
First Line	:	91-14 37TH AV
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	11373
Country	:	US
Telephone Number	:	718-779-1600
Fax Number	:	347-612-4162

Provider Business Practice Location Address
First Line	:	91-14 37TH AV
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	11373
Country	:	US
Telephone Number	:	718-779-1600
Fax Number	:	347-612-4162

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2008
Last Update Date	:	11/26/2018

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